RESUMO
Chronic renal disease patients under chronic dialysis (CRDD) have a multifactorial immunological deterioration with an increased risk of Candida infections. Incidence of Candida infections is increasing. Choice of suitable antifungal agents is limited due to the resistance of some species to several antifungals. Aim of the present study was to identify the distribution and antifungal susceptibility patterns of oral isolated Candida species from infected and colonized patients, as well as to investigate the risk factors for oral infection in patients on dialysis. Cross-sectional study, approved by the institutional bioethics committees was performed in CRDD patients. Demographic, clinic data, and oral mucosa samples were obtained. Infection diagnosis was established clinically and confirmed with exfoliative cytology, each sample was plated on CHROMagar Candida and incubated at 36°C for 2 days. Yeast species were identified by carbohydrate assimilation ID 32C AUX system and the apiweb database. For the antifungal susceptibility test, the M44 A-3 method (CLSI) using fluconazole (FCZ), miconazole (MCZ), nystatin (NYS), and voriconazole (VCZ). Study included 119 participants, the main cause of CRD was nephropathy due to DM2 (58%), and three-fourths of the patients were under hemodialysis. Candida prevalence was 56.3% of 67 colonized or infected patients, 88 isolates were obtained. Principal identified species were C. albicans (51.1%), C. glabrata (25%), and C. tropicalis (14.8%). C. glabrata showed a reduced response to FCZ in 50% of isolates and C. albicans had a reduced response in 16% of the isolates. Antifungal agent with the least efficacious response or with the lowest susceptibility in the isolates of these patients was MCZ, followed by VCZ and FCZ, whereas NYS induced the best antifungal response.
Assuntos
Antifúngicos/farmacologia , Candida/efeitos dos fármacos , Candida/isolamento & purificação , Candidíase Bucal/microbiologia , Boca/microbiologia , Insuficiência Renal Crônica/microbiologia , Adulto , Idoso , Idoso de 80 Anos ou mais , Candida/classificação , Candidíase Bucal/complicações , Candidíase Bucal/diagnóstico , Candidíase Bucal/epidemiologia , Estudos Transversais , Diabetes Mellitus Tipo 2/complicações , Diabetes Mellitus Tipo 2/microbiologia , Diabetes Mellitus Tipo 2/terapia , Nefropatias Diabéticas/epidemiologia , Nefropatias Diabéticas/microbiologia , Nefropatias Diabéticas/terapia , Farmacorresistência Fúngica/efeitos dos fármacos , Feminino , Humanos , Masculino , México/epidemiologia , Testes de Sensibilidade Microbiana , Pessoa de Meia-Idade , Diálise Renal/efeitos adversos , Diálise Renal/estatística & dados numéricos , Insuficiência Renal Crônica/complicações , Insuficiência Renal Crônica/epidemiologia , Insuficiência Renal Crônica/terapia , Adulto JovemRESUMO
Las fracturas-luxación del tobillo son muy frecuentes en los adultos y las lesiones descritas por Salter y Harris en pacientes en desarrollo también son comunes. Los autores presentan un caso de ruptura del ligamento tibio-peroneo inferior posterior en el tobillo izquierdo, en un paciente de 13 años de edad, cuyo diagnóstico inicial en radiografías simples fue de esguince de tobillo; sin embargo, se solicitó una TC del tobillo en donde se corroboró la lesión de este paciente tratado en el Hospital Infantil de Morelia. La TC como elemento de apoyo en el diagnóstico de la diástasis tibio-peronea inferior es de gran ayuda pues la ruptura del ligamento tibio-peroneo distal posterior de la mortaja en el tobillo pasa desapercibida en estos pacientes que son diagnosticados inicialmente como esguinces de tobillo.
Fracture-dislocations of the ankle are very frequent in adults. The injuries described by Salter and Harris in developing patients are also common. The authors present a case of tear of the posterior-inferior tibiofibular ligament of the left ankle in a 13 year-old patient. The initial diagnosis with plain X-rays was ankle sprain; however, an ankle CT scan confirmed the patient's injury and he was treated at Morelia's Children's Hospital. CT scan is an extremely useful aid in diagnosing inferior tibiofibular diastasis because the tear of the posterior distal tibiofibular ligament of the ankle mortise is missed in these patients, who initially are diagnosed as having an ankle sprain.
Assuntos
Adolescente , Humanos , Masculino , Traumatismos do Tornozelo/diagnóstico , Ligamentos Laterais do Tornozelo/lesões , Tomografia Computadorizada por Raios X/métodos , RupturaRESUMO
Fracture-dislocations of the ankle are very frequent in adults. The injuries described by Salter and Harris in developing patients are also common. The authors present a case of tear of the posterior-inferior tibiofibular ligament of the left ankle in a 13 year-old patient. The initial diagnosis with plain X-rays was ankle sprain; however, an ankle CT scan confirmed the patient's injury and he was treated at Morelia's Children's Hospital. CT scan is an extremely useful aid in diagnosing inferior tibiofibular diastasis because the tear of the posterior distal tibiofibular ligament of the ankle mortise is missed in these patients, who initially are diagnosed as having an ankle sprain.